9. peter hill
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9. peter hill

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    9. peter hill 9. peter hill Presentation Transcript

    • Aligning research with policy: the Evidence for Health Policy in Viet Nam (VINE) project
      • Ass Prof Peter S Hill
      • School of Population Health
      • The 2 nd International Conference on Public Health
      • among Countries in the Greater Mekong Sub-Region: 30 August 2010
    • Evidence-based policy: the global call
      • Limited resources, escalating costs, increasing demand, epidemiological shifts
        • Particular issues for Viet Nam as a MIC
        • Need for equitable resource allocation, effective and efficient interventions
      • Global demand for evidence to guide policy, to link research, policy, outcomes
      • Confidence that evidence can drive change
    • Evidence for Health Policy In Viet Nam (VINE) Project
      • The VINE project: UQ and MOH collaboration
        • Funded through the Atlantic Philanthropies
          • Health Strategy and Policy Institute
          • Can Tho Medical University
          • Hanoi Medical University
          • Hanoi School of Public Health
          • HCMC University of Medicine and Pharmacy
          • Hue University of Medicine and Pharmacy
          • Thai Nguyen Medical University
    • Four ‘branches’ of VINE
        • Reliable mortality and cause of death data
          • By age, gender, cause, using Verbal Autopsy
        • Burden of Disease analysis
          • Combine mortality with morbidity to calculate combined health burden and to compare
        • Cost-effective Analyses
          • Select key BOD issues and examine most cost effective policy interventions
        • Policy analysis
    • Building the Evidence
      • The evidence is increasingly clear:
        • Validated data on mortality and causes
        • Initial BOD completed
          • Injury, stroke, mental health, cancer, NCDs
        • CEA on Tobacco control completed
        • CEA on Alcohol, Hypertension, Diabetes, HIV, Mental health soon available
      • But translation into policy faces challenges
    • Policy analysis: the challenges
      • But the policy process is not rational: it is complex and depends on multiple factors
      • VINE policy process faces 5 challenges:
        • The challenge of chronology
        • The challenge of priority
        • The challenge of persuasion
        • The challenge of adequacy
        • The challenge of sustainability
    • The policy process: a theoretic framework
      • Kingdon (1994) suggests policy action happens when 3 streams converge:
        • The ‘problem’ stream: the issue is on the agenda
        • The ‘policy’ stream: there are solutions available
        • The ‘politics’ stream: there is a will for change
      • The evidence cycle needs to coincide with the policy cycle to influence change
      • VINE project is now entering ‘policy’ stream
    • The challenge of chronology: getting our timing right
      • Media analysis on helmet legislation
        • Using media to understand the policy process
      • Tobacco CEA available for proposed legislation
        • Costings based on pre-determined interventions
          • Able to demonstrate cumulative effects
          • But can also demonstrate potential for choices not made
      • Alcohol CEA currently examined by Hue Uni
        • ‘ Problem’ stream: scale of issues not yet recognized
    • The challenge of priority: getting new issues on the agenda
      • Burden of Disease analysis directly compares combined mortality/morbidity
      • Calculates priority listings for policy, but:
        • Mental health – high on BOD, but not on agenda
        • Tobacco – recognized risk factor, complex politics
          • State-owned industry – short term economic perspective
          • Projected impact: exposure, gender, aging population
        • Alcohol – dynamic social, economic context
    • The challenge of persuasion: right arguments for right audiences
      • Some interventions directed at individual at risk:
        • ‘ Quit’ campaigns for smokers
        • Brief interventions for ‘hazardous’ drinkers
      • Some need population shift for individual action:
        • Mandatory helmet legislation
      • Some need whole population strategies for effect:
        • Legislation to decrease salt content of foods
        • Smoke-free public areas to reduce passive exposure
    • The challenge of adequacy: getting ‘enough’ evidence for action
      • There are crucial time-frames for policy action
        • Definitive evidence takes time to provide
        • ‘ Good-enough’ evidence is sometimes enough
        • May need to construct from international experience
        • Enough evidence may never be ‘enough’
      • Tobacco: current smoking impact in 30 years
      • Sex ratio at birth: once confirmed, too late to act
      • Mental health: interaction with aging population
    • The challenge of sustainability: translating the evidence into action
      • Initiate identified interventions and measure change
        • Standardize medical certification in hospitals against VA
      • Evaluate current interventions, measure effectiveness
        • Savings from decreased TBI from helmet legislation
      • Identify synergies from potential interventions
        • Breath alcohol enforcement and alternative transportation
      • Advocate new policy alternatives and project CEA
        • Plain packaging for cigarettes
        • Salt reduction legislation
      • Thank you and our partners:
        • Health Strategy and Policy Institute
        • Government Statistics Office
          • Can Tho Medical University
          • Hanoi Medical University
          • Hanoi School of Public Health
          • HCMC University of Medicine and Pharmacy
          • Hue University of Medicine and Pharmacy
          • Thai Nguyen Medical University